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SAN J O A Q U I N Environmental Health Department <br /> COU NTY <br /> Water Usage Information <br /> PROJECT INFORMATION <br /> Application Number: Application Type: SITE APPROVAL <br /> Project Address: 18303 N HIGHWAY 88 LOCKEFORD,CA Project APN: 05131029 <br /> Applicant Name: JORDAN BALDWIN Title: PROFESSIONAL ENGINEER <br /> Applicant Address: 2769 BOEING WAY Cit /Zip: STOCKTON 95206 <br /> Applicant Phone:j 209.955.0110 Email: robby@rle.us <br /> Property Owner Name: JESUS E MEZA <br /> —Property Owner Address: PO BOX 980 Cit /Zip: LOCKEFORD 95237 <br /> Property Owner Phone: 209.329.1412 Email: imezatrucking@gmail.com <br /> SERVICES INFORMATION <br /> Please provide description below: <br /> Water Supply: WELL & PUMP ❑ Surface Water(Attach Water Rights Information) <br /> Domestic Wastewater Disposal: LEACH LINES 8 SEEPAGE PIT <br /> Process Wastewater Dischar e: Ponds: N/A Applicable WDR: I N/A <br /> Storm Drainage System: NON EXISTING <br /> WATER USAGE DATA <br /> Provide for total water usage at full buildout Number Persons/Da Gallons/Person/Da Total Gallons/Da <br /> Domestic Water Usage by Employees/Customers: 12 8 44 <br /> Type of Process/Irrigated Lands Total Gallons/Da <br /> Process Water Usage: N/A <br /> Process Water Usage: N/A <br /> Irrigation Water Usage: N/A <br /> Total Gallons Per Day: 44 <br /> PROPOSED WELL LOCATION <br /> Well Location Address: N/A I Cityl <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> PROPOSED WELL INFORMATION <br /> Well Total De th (ft):1 Acres to be Served by Well: <br /> Use of Well: <br /> ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): <br /> Anticipated Pumping Schedule (gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> SITING INFORMATION <br /> Distance To Nearest(ft): Onsite: Offsite: Distance To Nearest(ft): Onsite: Offsite: <br /> Wastewater Treatment System: 100'+ N/A Sources of Contamination: 100'+ N/A <br /> Other Wells: N/A N/A Pond/Lake: N/A N/A <br /> Sewer Lines: 1oo'+ N/A Stream/River: N/A N/A <br /> Animal or Fowl Enclosure: N/A N/A Navigable Waterway: N/A N/A <br /> Storm Drainage System: N/A N/A Potential Recharge Features: N/A N/A <br /> GROUNDWATER INFORMATION <br /> Depth(ft): Source/Date of Reference: Groundwater Subbasin: <br /> Current Depth to Water: UNKNOWN ❑ Cosumnes Subbasin(2-22.16) <br /> Highest Depth to Water: UNKNOWN ❑ Eastern San Joaquin Subbasin(5-22.01) <br /> Lowest Depth to Water: UNKNOWN ❑Tracy Subbasin(5-22.15) <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br /> 1 of 2 <br />